Papers by Lance Brendan Young
Journal of Groups in Addiction & Recovery, Oct 2, 2017
Addictive Disorders & Their Treatment, Jun 1, 2012
Objectives:Sponsoring another member of Alcoholics Anonymous (AA) is associated with improved sub... more Objectives:Sponsoring another member of Alcoholics Anonymous (AA) is associated with improved substance use outcomes, but little research examines who is asked (and agrees) to sponsor another member. The objective of this exploratory study is to describe the recovery-related characteristics and practices associated with AA sponsors. Methods:AA members (N=263) completed an anonymous online questionnaire about their background and recovery behaviors. On 9 characteristics and 4 practices, Pearson &khgr;2 and Student t tests were used to compare (a) current nonsponsors with sponsors; and (b) lifetime nonsponsors with those who had sponsored at some point. Results:How and when members entered AA had no association with the sponsor role. Sponsors, past and present, were characterized by having an AA home group, completing more steps, having longer sobriety, and reporting a greater degree of spiritual surrender. Current sponsors engaged more frequently than current nonsponsors in all 4 practices: performing AA service work, attending meetings, praying or meditating, and reading AA literature. Lifetime sponsors engaged more frequently than lifetime nonsponsors in all practices except praying or meditating. Tentative evidence suggested lifetime nonsponsors and former sponsors did not differ in AA practices, indicating the value of current/active sponsorship. Conclusions:Similar to having a sponsor, being a sponsor is associated with characteristics and practices supportive of AA engagement.
Journal of Groups in Addiction & Recovery, Jan 2, 2014
The 14th volume in the Routledge series Counseling and Psychotherapy with Boys and Men, Mark S. W... more The 14th volume in the Routledge series Counseling and Psychotherapy with Boys and Men, Mark S. Woodford’s Men, Addiction, and Intimacy (2012) addresses an issue that seems to concern more practitioners than researchers: the way male socialization and substance use reinforce each other. Demographic data reveal that, compared with girls and women, boys and men initiate substance use earlier, delay seeking help longer, and likely have poorer treatment outcomes (Isenhart, 2005). Despite these persistent differences, little research has proposed or tested ways addiction treatment can be adapted to meet the specific needs of men. Woodford attempts to fill this gap and emphasizes early in his book that “gender matters.” The organization of the book reflects Woodford’s primary concern of providing education and advice to mental health practitioners treating addiction in male clients. The first three chapters establish the relevance of gender to recovery, describe current research into the developing brain, and suggest specific steps to help male patients alter patterns of thought and behavior leading to substance use. Two fictional case studies are described in each of the remaining five chapters, which present potential challenges across the male life span, including early and late adolescence and early, middle, and older adulthood. In five appendices, Woodford helpfully provides age-appropriate worksheets that practitioners can ask their male clients to complete to better understand the interactions between their gender and their substance use. The treatment template described in the first three chapters focuses on the developing brain and the ways male gender norms, male socialization, and substance use may result in addiction. Woodford relies extensively on Daniel Siegel’s work on neuroplasticity to illustrate the ways dysfunctional behavioral and thought patterns form (Siegel, 2001) and the ways healthy therapeutic relationships can alter and strengthen neural circuitry (Siegel, 2010). This information detailing brain structures and neurochemistry is provided not simply for the edification of the practitioner. Woodford advocates educating male clients on the science of neuroplasticity and even describes a
Addiction, Oct 3, 2021
AimsTo test the effectiveness of an intervention, Al-Anon Intensive Referral (AIR), to facilitate... more AimsTo test the effectiveness of an intervention, Al-Anon Intensive Referral (AIR), to facilitate participation in Al-Anon Family Groups (Al-Anon).DesignMulti-site, randomized controlled trial of AIR versus Usual Care (UC) with follow-up assessments at 3, 6, and 12 months. The 12-month follow-up rate was 74%.SettingResidential alcohol use disorder (AUD) treatment programs in three US locations.ParticipantsConcerned Others (COs) of patients in treatment for AUD. COs were mostly women (77%) who were patients’ spouses (33%) or parents (25%).Intervention and ComparatorAIR (n=128) consisted of four sessions over 3 months with an Al-Anon Coach. UC (n=151) was the treatment program’s offer of educational sessions for COs.MeasurementsPrimary outcome: COs’ self-reports of any Al-Anon attendance (yes or no) at 3 months. Secondary outcomes: number of Al-Anon meetings and the CO-patient relationship (stressors, resources). Potential predictors of outcomes examined in generalized linear mixed models were their baseline value, time, CO-patient relationship type (marital or non-marital), treatment program, and condition.FindingsThere was no effect of condition for the primary outcome (28% in AIR, 21% in UC; Bayes Factor 1.86). Relationship stressors at follow-ups were more severe for COs in a marital relationship with the patient than for COs in a non-marital relationship; Beta (B) (95% confidence interval (CI)): 2.19 (1.07, 3.32). For CO-patient relationship resources at follow-ups, the main effect for condition was significant; B (95% CI): 1.33 (0.04, 2.61). COs assigned to the AIR condition had more resources than COs who were in the UC condition.ConclusionsRelative to usual care, Al-Anon Intensive Referral was not associated with increases in participation of Concerned Others (COs) in Al-Anon, but was associated with more resources in the CO-patient relationship.
Journal of Studies on Alcohol and Drugs, May 1, 2021
Objective:Growing up with an adult with an alcohol use disorder (AUD) is common and negatively af... more Objective:Growing up with an adult with an alcohol use disorder (AUD) is common and negatively affects adult functioning. This study examined two questions concerning the lived experience of growing up in a home with AUD.Method and Results:The first question asked how adults entering AUD treatment (n = 402) who had this lived experience (58%) compared to those who did not (42%) on indicators of alcohol use severity. Patients with lived experience reported alcohol use at a younger age, more times having been arrested and charged, and greater risk for future substance use. The second question examined concordance between patients and their concerned others on this lived experience (n = 277 dyads) and patients’ treatment outcomes 3 months later. The associations between patients’ lived experience and better treatment outcomes were stronger when patients’ concerned others had a concordant lived experience. When patient–concerned other dyads reported concordant lived experiences at baseline, patients had lower substance use and risk scores at the 3-month follow-up than when the dyads reported discordant lived experiences with regard to growing up in a home with AUD; effect sizes were small.Conclusions:Concordance and discordance on this lived experience could be considered in treatment planning for patients with AUD and their concerned others. Providers could ask about each member's childhood and aim interventions at helping dyads discuss their childhoods in ways that validate each other's needs and provide emotional support, without stigmatization. Delivery may consider relationship type (spousal or other) and be in educational or treatment sessions that include the dyad or one member.
Journal of Rural Health, Aug 9, 2016
The objective of this study is to determine whether rural residence is associated with trauma exp... more The objective of this study is to determine whether rural residence is associated with trauma exposure or posttraumatic stress disorder symptoms among military veterans seeking treatment for substance use disorder (SUD) through the Department of Veterans Affairs (VA), Delivering mental health services to veterans in rural areas is a challenge, so identifying differences in the causes and outcomes of trauma exposure would assist in effectively targeting service delivery. Methods: Veterans (N = 196) entering SUD treatment at 3 Midwestern VA treatment centers were designated as either urban or rural, based on rural-urban commuting area (RUCA) codes. The veterans completed the Life Events Checklist, the Posttraumatic Stress Disorder Checklist, and the Addiction Severity Index's psychiatric status subscale. Hypothesized relationships between rural-urban residence and both trauma exposure and symptomology were tested using independent samples t tests, chi-square tests, and ordinary least squares regression.
Alcoholism Treatment Quarterly, 2012
... In recent years, researchers have attempted to isolate AA components and practices to determi... more ... In recent years, researchers have attempted to isolate AA components and practices to determine their relative therapeutic contributions (Kelly, Magill, & Stout, 200914. Kelly, JF,Magill, M. and Stout, RL 2009. ... Kelly, JF, Magill, M. and Stout, RL 2009. ...
Journal of Groups in Addiction & Recovery, Apr 1, 2013
Members of Alcoholics Anonymous (AA) are more likely to be abstinent if they are sponsored, but l... more Members of Alcoholics Anonymous (AA) are more likely to be abstinent if they are sponsored, but little is known about those who connect with a sponsor. This exploratory survey study (N = 264) compared unsponsored AA members to sponsored AA members, and short-term sponsored members to long-term sponsored members. Compared with the unsponsored, the sponsored had less sobriety and greater spiritual surrender, and more frequently engaged in a range of AA practices. The short-term sponsored averaged 7.35 fewer years sober than the long-term sponsored, and they were more likely to attend meetings, perform service, and communicate with their sponsor.
Addiction research & theory, Nov 30, 2010
Motivational interviewing (MI), cognitive-behavioral therapy (CBT), and Alcoholics Anonymous (AA)... more Motivational interviewing (MI), cognitive-behavioral therapy (CBT), and Alcoholics Anonymous (AA) are the most common therapeutic approaches for alcoholism recovery. Whereas the former two are clinical treatments grounded in scientific theory, AA emerged as a peer-led program grounded in an array of scientific, social, and spiritual concepts. Researchers have failed to comprehensively identify AA's therapeutic mechanisms or to definitively link them to recovery outcomes. This failure may result from the false assumption that AA frames identity in the same way evidence-based psychological treatments do. This article explores the significance of identity to recovery from alcoholism. MI presumes a personal identity and CBT presumes a social identity. Measures of personal and social attributes are appropriate to these interventions. AA, however, promotes a relational identity which cannot be fully captured using measures of individual attributes. The implications for this shortcoming are presented, along with several suggestions to enhance future research.
International Journal of Mental Health and Addiction, Nov 16, 2010
The dominant theoretical approach to alcoholism research presumes linear, causal relationships be... more The dominant theoretical approach to alcoholism research presumes linear, causal relationships between individual cognitions and behavioral outcomes. This approach has largely failed to account for the recovery some alcoholics achieve in Alcoholics Anonymous (AA) because AA emphasizes the transformation of identity, framed in terms of relationships rather than cognitions and behaviors. George Kelly’s personal construct theory (PCT) provides a ready
Substance Use & Misuse, Sep 30, 2014
Background: Codependence is an ambiguous and disputed term often used to characterize both those ... more Background: Codependence is an ambiguous and disputed term often used to characterize both those who maintain relationships with alcoholics and those who seek help through resources such as Al-Anon Family Groups. Objectives: The purpose of this article is to better understand non-pathological reasons for maintaining alcoholic relationships and for help-seeking by detailing the costs and benefits of those choices. Methods: The costs and benefits both of remaining in an alcoholic relationship and of seeking help in Al-Anon were identified through a review of available research on alcoholic family systems, Al-Anon, and other mutual-support groups. Results: Alcoholic relationships may benefit concerned others by preserving selfidentity, social identity, values, security, stability, and hope. Costs of alcoholic relationships include physical symptoms, injury, mental problems, financial difficulty, legal troubles, and relational distress. Al-Anon is perceived beneficial for six primary reasons: Al-Anon philosophy, format, social support, accessibility, effectiveness, and potential to change the drinker's behavior. Possible costs of Al-Anon include marginalization of the concerned other, blame, codependent pathology, sexist stereotyping, substitute dependency, and perpetuating victimization. Conclusions/Importance: The identified costs and benefits of alcoholic relationships and help-seeking in Al-Anon can help to model decision-making processes using existing behavioral health frameworks without defaulting to the stigmatized and ambiguous codependence terminology.
Journal of Social Work Practice in The Addictions, Jul 3, 2015
This article identifies potential barriers to substance use recovery associated with rural reside... more This article identifies potential barriers to substance use recovery associated with rural residence. The evidence is discussed and illustrated with examples. Fourteen specific barriers to substance abuse recovery are identified within 4 broad categories: access to treatment services, access to other professionals, access to peer support groups, and barriers to confidentiality. Although telehealth, expansion of mental health care, intensive referral, and other efforts might enhance access to care, the evidence suggests practitioners and researchers should remain aware of community-level barriers to recovery from substance use disorder and work with clients to overcome them.
Journal of Gerontological Nursing, Nov 1, 2011
Home telehealth programs can enhance older adults’ access to care, but eliciting accurate informa... more Home telehealth programs can enhance older adults’ access to care, but eliciting accurate information regarding program effectiveness is challenging because patients are reluctant to criticize. This study sought accurate patient perspectives about both benefits and challenges of the Veterans Health Administration’s rapidly expanding care coordination/home telehealth program. Patients who completed the standard 8-item satisfaction survey were subsequently interviewed, and the transcripts were content analyzed to identify program functions most salient to patients and program components most challenging for patients. Interviews generally supported patients’ high survey ratings but also revealed some challenges that the survey did not capture. Program functions most salient to patients were providing access, educating or instructing, and monitoring or tracking. However, patients were frustrated by equipment problems as well as care coordinator inaccessibility and slow response. Gathering detailed information about patient perceptions of health care delivery is important so challenges can be addressed to meet patients’ expectations.
Journal of Groups in Addiction & Recovery, Apr 1, 2012
ABSTRACT Al-Anon Family Groups, commonly known as Al-Anon, is a mutual-help organization for rela... more ABSTRACT Al-Anon Family Groups, commonly known as Al-Anon, is a mutual-help organization for relatives and friends of people misusing alcohol and other substances. We first summarize Al-Anon's history and current membership and then describe its theoretical basis and helping approach. We review evidence for Al-Anon's active ingredients and outcomes and present a conceptual model to guide future research. Research opportunities include understanding Al-Anon newcomers, specifying Al-Anon's active ingredients, and examining potential synergistic influences between Al-Anon participation and identified substance misusers' participation in mutual-help groups such as Alcoholics Anonymous. We suggest that mutual-help and professional communities work together to facilitate early participation in Al-Anon by shortening the time between problem recognition and seeking help from the fellowship.
Chest, Feb 1, 2011
A lthough intensivist care is associated with lower ICU and hospital mortality and with reduced l... more A lthough intensivist care is associated with lower ICU and hospital mortality and with reduced length of stay, 1 only one-third of critically ill patients receive intensivist care, and the shortfall is projected to worsen. 2 As a result, hospitals increasingly rely on tele-ICU coverage. 3 For the purposes of this article, we defi ne tele-ICU coverage as the application of telemedicine 4 to in-hospital critical care units, thereby encompassing an array of technologies of varying complexity 5,6 that allow physical ICUs to access critical care experts in real time. At the present time, it is estimated that 10% of US hospitals use some form of tele-ICU coverage, Background: Remote coverage of ICUs is increasing, but staff acceptance of this new technology is incompletely characterized. We conducted a systematic review to summarize existing research on acceptance of tele-ICU coverage among ICU staff. Methods: We searched for published articles pertaining to critical care telemedicine systems (aka, tele-ICU) between January 1950 and March 2010 using PubMed, Cumulative Index to Nursing and Allied Health Literature, Global Health, Web of Science, and the Cochrane Library and abstracts and presentations delivered at national conferences. Studies were included if they provided original qualitative or quantitative data on staff perceptions of tele-ICU coverage. Studies were imported into content analysis software and coded by tele-ICU confi guration, methodology, participants, and fi ndings (eg, positive and negative staff evaluations). Results: Review of 3,086 citations yielded 23 eligible studies. Findings were grouped into four categories of staff evaluation: overall acceptance level of tele-ICU coverage (measured in 70% of studies), impact on patient care (measured in 96%), impact on staff (measured in 100%), and organizational impact (measured in 48%). Overall acceptance was high, despite initial ambivalence. Favorable impact on patient care was perceived by. 82% of participants. Staff impact referenced enhanced collaboration, autonomy, and training, although scrutiny, malfunctions, and contradictory advice were cited as potential barriers. Staff perceived the organizational impact to vary. An important limitation of available studies was a lack of rigorous methodology and validated survey instruments in many studies. Conclusions: Initial reports suggest high levels of staff acceptance of tele-ICU coverage, but more rigorous methodologic study is required.
Archives of internal medicine, Mar 28, 2011
Background: Although remote intensive care unit (ICU) coverage is rapidly being adopted to enhanc... more Background: Although remote intensive care unit (ICU) coverage is rapidly being adopted to enhance access to intensivists, its effect on patient outcomes is unclear. We conducted a meta-analysis to examine the impact of telemedicine ICU (tele-ICU) coverage on mortality and length of stay (LOS). Methods: We conducted a systematic review of studies published from January 1, 1950, through September 30, 2010, using PubMed, CINAHL (Cumulative Index to Nursing and Allied Health Literature), Global Health, Web of Science, the Cochrane Library, and conference abstracts. We included studies that reported data on the primary outcomes of ICU and in-hospital mortality or on the secondary outcomes of ICU and hospital LOS. Results: We identified 13 eligible studies involving 35 ICUs. All the studies used a before-and-after design. The studies included 41 374 patients (15 667 pre-tele-ICU and 25 707 post-tele-ICU patients). Tele-ICU coverage was associated with a reduction in ICU mortality (pooled odds ratio, 0.80; 95% confidence interval [CI], 0.66-0.97; P=.02) but not in-hospital mortality for patients admitted to an ICU (pooled odds ratio, 0.82; 95% CI, 0.65-1.03; P=.08). Similarly, tele-ICU coverage was associated with a reduction in ICU LOS (mean difference, −1.26 days; 95% CI, −2.21 to −0.30; P=.01) but not hospital LOS (mean difference, −0.64; 95% CI, −1.52 to 0.25; P=.16). Conclusion: Tele-ICU coverage is associated with lower ICU mortality and LOS but not with lower in-hospital mortality or hospital LOS.
Journal of Loss & Trauma, Mar 25, 2020
Among veterans, sexual trauma's associations with addiction problems and treatment effectiveness ... more Among veterans, sexual trauma's associations with addiction problems and treatment effectiveness are unclear. Veterans at three Midwest Veterans Affairs treatment sites were interviewed at baseline (N BL ¼ 193) and six-month follow-up (N FU ¼ 137) using the Life Events Checklist (LEC) and Addiction Severity Index-Lite (ASI-L). Those with sexual trauma had more severe baseline drug use, medical, and psychiatric status. Treatment improved all domains except employment and legal, but drug use and psychiatric disparities remained at follow-up. A family and social disparity emerged, and was the only follow-up domain predicted by sexual trauma (b ¼ 0.21, p < 0.05).
Alcoholism Treatment Quarterly, Dec 14, 2017
Community-based support group participation protects against substance use disorder (SUD) relapse... more Community-based support group participation protects against substance use disorder (SUD) relapse, but referrals during treatment are inconsistently delivered and may not acknowledge barriers facing rural patients. This formative evaluation of a rural intensive referral intervention (RAIR) to community-based support groups for veterans seeking SUD treatment surveyed patients (N = 145) and surveyed and interviewed treatment staff (N = 28). Patients and staff did not differ significantly on quantitative ratings of the helpfulness of, or satisfaction with, seven RAIR components, but staff did not deliver the intervention consistently or as designed, citing two themes: lack of commitment and lack of resources.
Journal of Interpersonal Violence, Jan 26, 2020
Posttraumatic stress disorder (PTSD) dramatically increases the risk of both substance use disord... more Posttraumatic stress disorder (PTSD) dramatically increases the risk of both substance use disorder (SUD) and suicide in veterans. Military-related trauma, however, may not be the only or most significant trauma experienced by veterans. Trauma exposure is high among those joining the military. This study sought to identify the prevalence of five types of childhood trauma (emotional, physical, and sexual abuse and emotional and physical neglect) and three adult trauma symptom clusters (intrusive thoughts, avoidance, and hyperarousal) among veterans seeking SUD treatment and to clarify the associations between types of trauma and specific symptom clusters. Veterans at three Veterans Affairs (VA) SUD treatment facilities in the Midwest completed surveys at treatment entry ( n1 = 195) and at 6-month follow-up ( n2 = 138). Measures included the Childhood Trauma Questionnaire-Short Form and the PTSD Checklist, either a military or a civilian version, depending on whether the most traumatic event occurred in or out of the military. The prevalence of childhood trauma was high, ranging from 40.5% experiencing physical abuse down to 22.8% experiencing sexual abuse. At baseline, 60.2% of the military trauma group met criteria for PTSD, compared with 33.9% of the civilian trauma group, a significant difference, χ2(1, N = 195) = 14.46, p &amp;lt; .01. Childhood emotional and physical abuse were moderately associated with intrusion and hyperarousal in the military trauma group, but in the civilian trauma group a broader spectrum of childhood traumas were associated with a broader array of symptom clusters, including avoidance. At follow-up, symptoms improved and were less associated with childhood trauma. These findings illuminate the persistence of effects of childhood trauma and recommend more targeted PTSD treatments.
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Papers by Lance Brendan Young